AB1232 HIGHER PAIN SCORE MEASURED WITH VISUAL ANALOG SCALE HAS SIGNIFICANT HIGHER RISK OF INCIDENT BONE FRAGILITY FRACTURE
Authors: I. Yoshii, N. Sawada, T. Chijiwa
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Bone fragility fracture (BFF) is one of serious troublesome incident in treating patient with rheumatoid arthritis (RA). Previously, sustaining clinical remission with simplified disease activity index (SDAI) was clarified that prevents occurrence of incident BFF [1]. <h3>Objectives</h3> We hypothesized that pain degree would correlates with occurrence of incident BFF, because that caused gait disability and bone fragility. The aim of this study is to clarify this issue. <h3>Methods</h3> A retrospective cohort study data was used in the study. Postmenopausal female patients who matched the EULAR/ACR classification criteria under the T2T since August 2010, have been treating RA and were measured bone mineral density (BMD) with dual-energy X-ray absorptiometry, were recruited. The initial target of therapy is the attainment of remission with SDAI within 6 months of initiation. The primary outcome was incident BFF. Follow-up started at BMD measurement (baseline) and continued until the development of the first fracture or censoring at death, loss to follow-up or end of the study. Binary logistic regression analyses (BLR) were determined for incident BFF incidence up to the last observation. Risks for the incidence of BFF was classified as RA specific and general candidate. In general candidate, comorbidities that might affect the incidence of BFF, such as lifestyle-related diseases, increased ability to fall, and pain score using visual analog scale (PS-VAS) were included. anti-citrullinated polypeptide antibodies and rheumatoid factor titers, SDAI score, Health Assessment Questionnaire Disability Index, and Sharp/van der Heijde score were included in RA specific candidate risks. Each evidence was evaluated using Cox regression analysis to identify significantly higher risk factors within 5% in univariate models and to evaluate using multivariate model. In the variants with significant higher risk ratio in the Cox regression analysis, Receiver operation characteristics (ROC) was examined to determine cut-off index (COI). Finally, statistically evident variants in the ROC study was examined to clarify a validity of the variant as a risk factor using Kaplan-Meier survival curve analysis again. <h3>Results</h3> A total of 239 patients were recruited. Mean age was 73.6 years and mean follow up period was 52.4 months. Mean T-score in the lumbar spine and femoral neck were -2.10 and -1.85. Using BLR, PS-VAS, estimated glomerular filtration ratio based on cystatin C (eGFR_CysC), prevalent BFF (pr-BFF), and SDAI remission rate were significant correlation with incident BFF. In these, PS-VAS and pr-BFF demonstrated significant higher risk ratios using a multivariate cox regression analysis. In the ROC, COI of PS-VAS was 24.6 and the area-under-the-curve was 0.669 (p&lt;0.001). Finally, PS-VAS ≥ 24.6 mm had 3.506 fold higher hazard ratio than PS-VAS &lt; 24.6 mm using Kaplan-Meier survival curve analysis. <h3>Conclusion</h3> These results suggested pain control in treating RA is the important task in order to avoid incident BFF in postmenopausal female patients with RA. <h3>Reference</h3> [1]Yoshii I, et al. Impact of sustaining SDAI remission for preventing incident of bone fragility fracture in patient with rheumatoid arthritis. Ann Rheum Dis. 2022:81;296-9. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.